Date 2013/2/20
Type of manuscript: letter to editor
Manuscript title: Alcoholism Correlates With Increased Risk of Parkinson's disease in
Taiwan: A Population-based Cohort Study
Running head: Alcoholism and Parkinson's disease
Authors' full names:
Shih-Wei Lai1,2, Li-Ting Su3, Fung-Chang Sung4.5, Kuan-Fu Liao6,7,8
1School of Medicine, 4Department of Public Health, and 6Graduate Institute of Integrated
Medicine, China Medical University, Taichung, Taiwan
2Department of Family Medicine, 3Trauma and Emergency Center, and 5Management Office
for Health Data, China Medical University Hospital, Taichung, Taiwan
7Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
8Department of Health Care Administration, Central Taiwan University of Science and
Technology, Taichung, Taiwan
Corresponding author: Kuan-Fu Liao, MD and MS
Department of Internal Medicine, Taichung Tzu Chi General Hospital, No.66, Sec. 1, Fongsing Road, Tanzi District, Taichung City, 427, Taiwan
Phone: 886-4-2205-2121 Fax: 886-4-2203-3986
E-mail: [email protected]
Introduction
So far, there are conflicting results about the association between alcohol consumption and Parkinson's disease. In Ragonese et al’s case-control study in Italy, alcohol consumption is
inversely related to Parkinson's disease (OR = 0.61, 95% CI = 0.39-0.97) 1. In Hernán et al’s study,
beer drinkers have a 30% lower incidence of Parkinson's disease than non–beer drinkers (95% CI =
0.5-0.9) 2. However, the other study has shown no association between alcohol consumption and
Parkinson's disease 3. As concern from public health, if more epidemiological information can be
illustrated between alcoholism and Parkinson's disease, preventive strategy of Parkinson's disease may be performed by early targeted intervention to alcoholism. To clarify the impact of alcohol consumption, we conducted this population-based cohort study to explore the relationship between alcoholism and Parkinson's disease in Taiwan.
We used data retrieved from claim information of the National Health Insurance program, implemented in Taiwan in March 1995. This insurance program has covered more than 99% of all national population. The details of insurance program can be found in previous studies 4-6.
The criteria of diseases were defined according to International Classification of Diseases (ICD) 9th Revision. This follow-up design would investigate whether individuals with alcoholism
(according to International Classification of Diseases 9th Revision-Clinical Modification, ICD-9
codes 303, 305.00, 305.03, V11.3, V79.1 and V61.41) were at an increased risk of Parkinson's disease (ICD-9 codes 332). The index date was defined as the date of diagnosing alcoholism.
If Parkinson's disease was diagnosed before the date at which cases and controls were identified, these people were excluded from this study. The exposure group consisted of 2244 patients aged 20
years or older with newly diagnosed alcoholism and the non-exposed group consisted of 8976 people without alcoholism (exposed group: non-exposed group = 1:4). Both groups were matched with age and index date in 2000-2007. Among 11220 eligible study subjects, there were 6171 (55%) males and 5049 (45%) females.
The follow-up results showed a higher incidence of Parkinson's disease in the alcoholism group than in the non-alcoholism group (20.7 vs. 11.9 per 10000 person-years, P < 0.0001). After adjusted for confounding factors, multivariate analysis demonstrated that patients with alcoholism were 2.25 times more likely to develop Parkinson's disease than non-alcoholism subjects (hazard ratio =2.25, 95% confidence interval= 1.31-3.86).
The evidence has shown that ethanol has the effect to reduce dopamine turnover in the substantia nigra and caudate nucleus in rats and further to interfere with dopaminergic transmission, which may be involved in the behavioral effects of ethanol . To date, some case reports have illustrated that alcoholism can induce or aggravate Parkinsonism . Although the pathogenesis underlying alcoholism-associated Parkinsonism remains unclear, these above case reports indicate that alcohol may impair central dopaminergic mechanism in humans .
We conclude that alcoholism correlates with increased risk of Parkinson's disease. The mechanism remains to be explored through future research.
Funding
This study was supported in part by Taiwan Department of Health Clinical Trial and Research Center of Excellence (DOH102-TD-B-111-004).The funding agency did not influence the study
design, data collection and analysis, decision to publish, or preparation of the manuscript.
Acknowledgement
The authors thank the National Health Research Institute in Taiwan for providing us the insurance claims data.
Conflict of Interest Statement
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